Future Renal Function Research Articles

Comparative analysis of kidney function prediction: traditional statistical methods vs. deep learning techniques.

Chronic kidney disease (CKD) represents a significant public health challenge, with rates consistently on the rise. Enhancing kidney function prediction could contribute to the early detection, prevention, and management of CKD in clinical practice. We aimed to investigate whether deep learning techniques, especially those suitable for processing missing values, can improve the accuracy of predicting future renal function compared to traditional statistical method, using the Japan Chronic Kidney Disease Database (J-CKD-DB), a nationwide multicenter CKD registry. From the J-CKD-DB-Ex, a prospective longitudinal study within the J-CKD-DB, we selected individuals who had at least two eGFR measurements recorded between 12 and 20months apart (n = 22,929 CKD patients). We used the multiple linear regression model as a conventional statistical method, and the Feed ForwardNeural Network (FFNN) and Gated Recurrent Unit (GRU)-D (decay) models as deep learning techniques. We compared the prediction accuracies of each model for future eGFR based on the existing data using the root mean square error (RMSE). The RMSE values were 7.5 for multiple regression analysis, 7.9 for FFNN model, and 7.6mL/min/1.73m2 for GRU-D model. In the subgroup analysis according to CKD stages, lower RMSE values were observed in higher stages for all models. Our result demonstrate the predictive accuracy of future eGFR based on the existing dataset in the J-CKD-DB-Ex. The accuracy was not improved by applying deep learning techniques compared to conventional statistical methods.

Predicting chronic kidney disease progression in children with posterior urethral valves

ObjectivePosterior urethral valves (PUV) leads to early chronic kidney disease (CKD) and renal failure in some children, while others may maintain preserved kidney function even into adulthood. Our goal was to assess the association between early imaging features and CKD progression in children with PUVs. We hypothesized that imaging features identified on PRUS and VCUG would be associated with CKD progression and could` be used in conjunction with nadir creatinine to predict future renal function. MethodsFollowing individual institutional research board approvals, we performed a retrospective cohort study at two institutions. Electronic medical records were queried to identify all patients with a history of PUVs treated between 1990 and 2022. Children who presented in the first year of life and had their initial renal bladder ultrasound (RBUS) and voiding cystourethrogram (VCUG) performed within the first 90 days of life were included. The primary outcome, CKD progression, was defined as development of ESKD requiring dialysis or renal transplant or a decline in eGFR of greater than 50%. Clinical variables of interest included: findings on initial RBUS (urinoma, cystic dysplasia, solitary kidney), vesicoureteral reflux on initial postnatal VCUG (degree and laterality), and nadir creatinine. Hazard ratios (HRs) were calculated from Cox proportional hazards regression for univariate and multivariable regression. ResultsOut of 537 patients with PUVs, 274 met our inclusion criteria. Median follow up was 5.84 years (IQR 2-10.2), and 55 patients (20%) reached our primary outcome. Multivariable analysis showed the presence of any degree of vesicoureteral reflux, HR 3.1 (95% CI 1.62-5.93), and nadir creatinine, HR 5.53 (95% CI 4-7.64), were predictive of CKD progression When nadir creatinine within the first year of life is used as a sole predictor of CKD progression, the area under the receiver-operator curve was 0.89 (95% CI .83-.91). ConclusionsThis study confirms nadir creatinine as a strong predictor for CKD progression and ESKD in patients with PUVs. In our cohort, the presence of any degree or laterality of vesicoureteral reflux, was also a significant predictor for CKD progression.

Corticomedullary Differentiation in Fetal Kidneys: A Necessary Evil?

AbstractRenal corticomedullary differentiation (CMD) is a crucial indicator of fetal renal health and is detectable as early as 15 to 16 weeks of gestation. Abnormalities in CMD, such as accentuation or loss, may signal underlying renal diseases. CMD assessment via prenatal ultrasound evolves dynamically throughout gestation, reflecting changes in cortical echogenicity and cystic structures. While CMD alterations can indicate conditions like glomerulonephritis or obstructive uropathies, they also offer prognostic insights into future renal function. This case report highlights the importance of early detection and comprehensive evaluation of CMD for optimising prenatal renal care.

Triglyceride-Glucose Index Associated with Future Renal Function Decline in the General Population.

The triglyceride-glucose index (TyG index), calculated as the logarithmic product of fasting triglyceride and glucose concentrations, is recognized as a simple marker of insulin resistance. However, the association between the TyG index and future decline of renal function remains unclear in the general population. To investigate whether the TyG index was associated with future decline of renal function in the general population who had not progressed to chronic kidney disease stage G2. Retrospective longitudinal observational cohort study. Individuals who received a population-based health checkup at JA Ehime Kouseiren Checkup Center from 2010 to 2019 (n = 134,007). Individuals without data of baseline fasting triglyceride or glucose levels, or baseline and follow-up data of estimated glomerular filtration rate (eGFR), or those with baseline eGFR < 60mL/min/1.73 m2 were excluded. Future renal function decline, defined as a ≥ 25% decrease in eGFR from baseline. Of 10,758 participants, 8,076 were classified into the low TyG index group (TyG index < 8.76, 1st to 3rd quartiles) and 2,682 into the high TyG index group (TyG index ≥ 8.76, 4th quartile). The mean follow-up period was 37.8 ± 23.6months. The incidence rates of renal function decline were 0.31 and 0.69 per 100 person-years in the low and high TyG index groups, respectively. In multivariate Cox proportional hazard models, high TyG index was significantly associated with future renal function decline (hazard ratio 2.25, 95% CI 1.40-3.60). This association was consistent across subgroups stratified by age, sex, body mass index, baseline eGFR, and diagnosed hypertension, diabetes, or dyslipidemia. In the general population, high TyG index was associated with future renal function decline. The TyG index may be useful in identifying individuals at high risk for future renal function decline in the setting of health checkups.

#2478 Multiparametric magnetic resonance imaging predicts decline of kidney function but does not perform better than diffusion-weighted MRI alone

Abstract Background and Aims Renal cortical interstitial fibrosis, typically measured by biopsy, is a critical factor for kidney function prognosis. Diffusion-weighted magnetic resonance imaging (DW-MRI) has emerged as a novel promising non-invasive method to assess the degree of fibrosis. We have previously shown that there is a strong correlation between the cortico-medullary apparent diffusion coefficient difference (ΔADC) and histologically assessed fibrosis. We also developed a model based on ΔADC, eGFR and proteinuria that calculates a risk score for future renal function decline. Multiparametric MRI combines DW-MRI with other sequences and can provide synchronized insights into perfusion, diffusion, oxygenation, and tissue characterization (T1 and T2 mappings). Our current research evaluates whether additional multiparametric MRI sequences increase the power of the DW-MRI based model to predict renal function decline. Method We used data from 197 patients with either chronic kidney disease (42) or allograft kidneys (155). Each participant underwent a biopsy followed by a multiparametric MRI within the following week. The median follow-up period was 2.2 years, during which laboratory parameters were recorded. The primary endpoint was defined as a rapid decline in kidney function, characterized by a reduction in eGFR of over 30%, or the initiation of dialysis. Prognostic factors for the primary outcome were analyzed using both univariable and multivariable Cox regression models, incorporating MRI parameters (ΔADC, cortical and ΔT1, cortical and ΔT2), eGFR, and proteinuria. Results At baseline, mean eGFR was 54.5 ml/min/1.73 m2 (SD 23.8) and mean proteinuria was 0.90 g/24 h (SD 2.4). Rapid decline of renal function occurred in 54 patients after a median time of 1.1 years (interquartile range, 0.9–2.1 years). In univariable survival analysis, cortical T1 measure and cortico-medullar difference ΔT2 have showed the best association to rapid kidney function decline. Compared to our previously established model incorporating ΔADC, eGFR, and proteinuria, adding cortical T1 did not significantly improve the hazard ratio (from 4.62 (95% CI: 1.56–13.67) to 4.36 (95% CI: 1.46–13.02) with cortical T1 inclusion). Harrell's C-index marginally increased with cortical T1, suggesting no significative improvement in prognostic capacity (0.77 versus 0.79 with cortical T1). Additionally, adjusting the regression model for ΔT2 yielded no enhancement in predictive power. Conclusion Our results did not demonstrate an enhancement of the prognostic power of the composite score with the inclusion of additional MRI sequences. Consequently, no clear benefit of multiparametric MRI on top of DW-MRI was observed. Additional research is required to investigate this issue more thoroughly.

Association of baseline electrocardiographic left ventricular hypertrophy with future renal function decline in the general population

Electrocardiographic left ventricular hypertrophy (LVH) could predict adverse renal outcomes in patients with hypertension. This study aimed to investigate the association between electrocardiographic LVH and future decline in renal function in the general population using a dataset of population-based health checkups from 2010 to 2019 including 19,825 participants. Electrocardiographic LVH was defined according to the Minnesota code. Renal function decline was defined as a decrease of ≥ 25% in the estimated glomerular filtration rate from baseline to < 60 mL/min/1.73 m2. Electrocardiographic LVH was found in 1263 participants at the baseline visit. The mean follow-up period was 3.4 ± 1.9 years. The incidence rates of renal function decline were 0.30 and 0.78 per 100 person-years in the non-LVH group and LVH groups, respectively. Electrocardiographic LVH was associated with the risk for renal function decline in the adjusted analysis (hazard ratio 1.69, 95% confidence interval 1.14–2.50, P = 0.009). This association was comparable across subgroups stratified by age, sex, body mass index, diagnosed hypertension, systolic blood pressure, hemoglobin A1c, and urinary protein. This study underscores the usefulness of electrocardiographic LVH to detect high-risk individuals for renal function decline in the setting of health checkups in the general population.

PS-C27-7: ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY CAN PREDICT FUTURE DECLINE OF RENAL FUNCTION IN GENERAL POPULATION

Objective: Electrocardiographic left ventricular hypertrophy (LVH) has been shown to be associated with future renal function decline in patients with chronic kidney disease. However, this association remains unclear in general population. We aimed to elucidate the association between baseline LVH on electrocardiogram and future renal function decline using health checkup data. Design and method: We used a dataset derived from the annual health-screening program from 2010 to 2019. Patients with baseline estimated glomerular filtration rate (eGFR) &lt; 60 ml/min/1.73m2 were excluded. LVH was determined by the electrocardiographic voltage criteria at baseline. Association between LVH and renal function outcomes, specifically ≧ 30% decline in eGFR from baseline, eGFR decline less than 60 ml/min/1.73m2 and 45 ml/min/1.73m2, were analyzed using multivariate Cox proportional hazard models. Results: Among total of 19,825 participants, 1,263 had LVH and 18,562 no LVH. LVH group was older and more male and current smokers, and to complicated with more hypertension, and higher systolic (136.7 ± 20.9 vs 123.7 ± 19.1 mmHg, P &lt; 0.001) and diastolic blood pressure (81.8 ± 12.6 vs 74.6 ± 12.0 mmHg, P &lt; 0.001). Baseline eGFR and HbA1c were comparable between the groups. Incidence of ≧ 30% eGFR decline was significantly higher in LVH group (P &lt; 0.001, log-rank test). LVH was associated with ≧ 30% eGFR decline (HR 1.92, 95% CI 1.26–2.91, P = 0.002) and eGFR &lt; 45 ml/min/1.73m2 (HR 3.12, 95% CI 1.54–6.35, P = 0.002) after adjustment. LVH was not associated with eGFR &lt; 60 ml/min/1.73m2 in the overall population. However, when analyzed this association in subpopulation stratified by baseline SBP (&lt; 140 and ≧ 140 mmHg), LVH was associated with eGFR &lt; 60 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg (HR 1.40, 95% CI 1.10–1.79, P = 0.007) but not in those with SBP &lt; 140 mmHg (HR 0.88, 95% CI 0.68–1.14, P = 0.32) (P for interaction between LVH and baseline SBP = 0.005). Similarly, LVH was significantly associated with ≧ 30% eGFR decline and eGFR &lt; 45 ml/min/1.73m2 in persons with SBP ≧ 140 mmHg but not in those with SBP &lt; 140 mmHg, although the interaction between LVH and baseline SBP was not significant in these renal outcomes. Conclusion: Electrocardiographic LVH was independently associated with the rate of renal function decline among general population. The association between LVH and future renal function decline might be stronger in people with SBP ≧140 mmHg.

Autosomal Dominant Polycystic Kidney Disease: Role of Imaging in Diagnosis and Management.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disorder with progressive renal function decline, and disease severity is determined based on the type of genetic mutation. The diagnosis is usually established at imaging, primarily at US, and is based on age-dependent criteria and the number of visible cysts. ADPKD is classified into class 1 (typical) and class 2 (atypical) according to the Mayo Clinic Imaging Classification (MCIC) system. Height-adjusted total kidney volume (TKV) has emerged as a predictor of future renal function decline and renal failure in ADPKD, and several methods can be used for estimation. MCIC class 1 ADPKD is further subdivided into five types based on height-adjusted TKV (A, B, C, D, and E). Patients with a larger height-adjusted TKV (ie, MCIC 1C-E) are at high risk for progression to end-stage renal disease and will potentially benefit from vasopressin receptor antagonists, which have been shown to reduce the rate of cyst growth and slow renal function decline. Other renal complications primarily relate to hemorrhage within cysts or cyst infections. Subtraction images are key for assessment of complex cysts when malignancy is suspected, as the presence of protein and blood can limit the assessment for an enhancing component. The radiologist has a central role in establishing a diagnosis, excluding mimics, identifying complications, assessing severity, and predicting future renal failure. Interventional radiologists play a therapeutic role in management of complications by cyst drainage, sclerotherapy, or embolization. © RSNA, 2022 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Pediatric metanephric adenoma with Fanconi-Bickel syndrome: a case report and review of literature.

BackgroundMetanephric adenoma (MA) is a rare benign renal tumor that resembles renal cell carcinoma and Wilms’ tumor in radiological as well as pathological appearance. It can present at any age or gender, and it is extremely rare in the pediatric age group with less than 50 reported cases. Fanconi–Bickel syndrome (FBS) is a rare autosomal recessive disorder of carbohydrate metabolism. Herein, we report a rare incidence of MA in a boy with a genetically confirmed FBS who underwent a nephron-sparing surgery.Case presentationA 21-month-old boy was referred to the pediatric urology clinic for further evaluation of an incidentally discovered left renal mass. His laboratory investigations showed normal renal function, hypophosphatemia, high blood glucose level, markedly elevated serum alkaline phosphatase, and low serum vitamin D. Blood picture showed signs of polycythemia and urinalysis showed glucosuria and aminoaciduria. Genetic testing was positive for Fanconi–Bickel syndrome. Radiological investigations were carried out with abdominal ultrasound and computerized tomography (CT) with intravenous contrast documented a sharply marginated peripheral hypoechoic hypovascular homogeneously enhancing mass at the upper pole of the left kidney measuring 2.0 × 1.8 × 2.0 cm. The child was admitted and started on supportive treatment until his medical condition was stabilized, then underwent elective open left partial nephrectomy via a left upper transverse abdominal transperitoneal incision. The excised renal mass was sent for histopathological assessment and was found to be a tumor composed of tightly packed tubules with no mitotic figures or necrosis and scanty cytoplasm consistent with MA. After good hydration and tumor resection, his polycythemia gradually improved. The patient was discharged home in a good condition with his proper replacement therapies. His follow-up abdominal ultrasound after 12 months showed no signs of recurrence.ConclusionsMetanephric adenoma is extremely rare in the pediatric age group, especially in those who have a FBS. The only way to diagnose and treat this tumor is by surgical resection as most patients are asymptomatic. A nephron-sparing surgery is better for this age group in which the future renal function is considered.

Plasma Free Thiol Levels during Early Sepsis Predict Future Renal Function Decline.

Sepsis is a life-threatening syndrome characterized by acute organ dysfunction due to infection. In particular, acute kidney injury (AKI) is common among patients with sepsis and is associated with increased mortality and morbidity. Oxidative stress is an important contributor to the pathogenesis of sepsis-related AKI. Plasma free thiols (R-SH) reflect systemic oxidative stress since they are readily oxidized by reactive species and thereby serve as antioxidants. Here, we aimed to assess the concentrations of serum free thiols in sepsis and associate these with major adverse kidney events (MAKE). Adult non-trauma patients who presented at the emergency department (ED) with a suspected infection were included. Free thiol levels and ischemia-modified albumin (IMA), a marker of oxidative stress, were measured in plasma at baseline, at the ward, and at three months, and one year after hospitalization. Plasma free thiol levels were lower at the ED visit and at the ward as compared to three months and one year after hospital admission (p < 0.01). On the contrary, plasma levels of IMA were higher at the ED and at the ward compared to three months and one year after hospital admission (p < 0.01). Furthermore, univariate logistic regression analyses showed that plasma free thiol levels at the ED were inversely associated with long-term renal function decline and survival at 90 days (MAKE90) and 365 days (MAKE365) (OR 0.43 per standard deviation [SD] [0.22–0.82, 95% CI], p = 0.011 and OR 0.58 per SD [0.34–0.96, 95% CI], p = 0.035, respectively). A multivariate regression analysis revealed an independent association of plasma free thiols at the ED (OR 0.52 per SD [0.29–0.93, 95% CI], p = 0.028) with MAKE365, even after adjustments for age, eGFR at the ED, SOFA score, and cardiovascular disease. These data indicate the clear role of oxidative stress in the pathogenesis of sepsis-AKI, as reflected in the lower plasma free thiol levels and increased levels of IMA.

Changes in serum uric acid levels as a predictor of future decline in renal function in older adults with type 2 diabetes.

Given that factors affecting renal function remain unknown, this study aimed to identify key predictors of estimated glomerular filtration rate (eGFR) deterioration, which is a representative of renal function decline in older adults with type 2 diabetes (T2DM). In an exploratory prospective observational study, we enrolled 268 Japanese people with T2DM aged ≥20 years who were followed up at Shinshu University Hospital. Among those, 112 eligible individuals aged ≥65 years were included in the present study. Factors associated with 3-year changes in eGFR (ΔeGFR) and eGFR deterioration (ΔeGFR < 0) were identified using bivariate and multivariable analyses. Regarding baseline values of the subjects, the mean age was 73.5 years, mean blood pressure was 131/74 mm Hg, mean hemoglobin A1c was 7.1%, mean eGFR was 62.0 mL/min/1.73 m2, mean urinary albumin excretion was 222.6 mg/gCre, and mean serum uric acid (UA) was 5.5 mg/mL. In bivariate analysis, the 3-year change in UA (ΔUA) levels was significantly correlated with ΔeGFR (r = −0.491, P < .001), but the baseline UA was not (r = 0.073, P = .444). Multiple linear regression analysis revealed that ΔUA was a significant negative predictor of ΔeGFR in the model that included sex, age, body mass index, serum albumin, and ΔUA as explanatory variables. Moreover, multiple logistic regression analysis demonstrated that ΔUA had a positive association with ΔeGFR <0 (odds ratio 2.374; 95% confidence interval 1.294–4.357). Thus, future renal function decline can be predicted by ΔUA but not by baseline UA in older adults with T2DM. Further research is needed to determine whether lowering the serum UA level can prevent eGFR decline.

Predicting Future Renal Function Decline in Patients with Autosomal Dominant Polycystic Kidney Disease Using Mayo Clinic Classification

Introduction: Mayo clinic classification (MCC) has been proposed in patients with autosomal dominant polycystic kidney disease (ADPKD) to identify who may experience a rapid decline of renal function. Our aim was to validate this predictive model in a population from southern Spain. Methods: ADPKD patients with measurements of height-adjusted total kidney volume (HtTKV) and baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m² were selected. Last eGFR was estimated with Mayo Clinic (MC) equation and bias and accuracy were studied. We also analyzed predictive capacity of MCC classes using survival analysis and Cox regression models. Results: We included 134 patients with a mean follow-up of 82 months. While baseline eGFR was not different between classes, last eGFR decreased significantly with them. eGFR variation rate was different according to the MCC class with a more rapid decline in 1C, 1D, and 1E classes. Final eGFR predicted was not significantly different from the real one, with an absolute bias of 0.6 ± 17.0 mL/min/1.73 m². P10 accuracy was low ranging from 37.5 to 59.5% in classes 1C, 1D, and 1E. Using MC equation, the rate of eGFR decline was underestimated in 1C, 1D, and 1E classes. Cox regression analysis showed that MCC class is a predictor of renal survival after adjusting with baseline eGFR, age, sex, and HtTKV, with 1D and 1E classes having the worst prognosis. Conclusion: MCC classification is able to identify patients who will undergo a more rapid decline of renal function in a Spanish population. Prediction of future eGFR with MC equation is acceptable as a group, although it shows a loss of accuracy considering individual values. The rate of eGFR decline calculated using MC equation can underestimate the real rate presented by patients of 1C, 1D, and 1E classes.

813-P: Demonstrating the Economic Health Benefit of Using the PromarkerD In Vitro Diagnostic Test in the Prediction of Diabetic Kidney Disease

Diabetic kidney disease (DKD) develops in 1 in 3 people with type 2 diabetes (T2D) and is the leading cause of end-stage renal disease (ESRD). DKD currently costs the US healthcare system USD 50 billion annually. PromarkerD is a simple biomarker-based blood test that can predict future renal function decline in T2D patients who have no or mild existing DKD (eGFR &amp;gt;30). This study estimated the net savings to US payers from covering the PromarkerD test versus current standard of care (SOC). Model inputs included costs and frequency of testing, costs associated with changes to patient medication strategies, and cost-savings from slowed DKD progression and averted ESRD interventions (dialysis and kidney transplants). All estimates and inputs for the model were collected from recent peer-reviewed literature, established insurance payment rates, and PromarkerD clinical studies. Results showed that over ten years the net savings for US payers by adopting PromarkerD testing for T2D patients (KDIGO DKD category G1-3b) would exceed USD 14 billion and the equilibrium point (costs equal savings) can be achieved after two years. Primarily, savings arise from slower DKD stage progression, with contributions from delayed dialysis and transplants, and also from fewer unplanned dialyses. This economic study demonstrates that improved management of T2D patients through the use of early, accurate and cost-effective prognosis with the PromarkerD test could result in substantial savings to US payers in the treatment of DKD. Employing this alternative PromarkerD testing regime over the current SOC would enable early interventions for at-risk patients, thereby decreasing the need for expensive interventions such as dialysis and transplants, or unnecessary adoption of new therapeutic treatments. Disclosure W. Burchenal: Research Support; Self; Proteomics International. M. Datar: Research Support; Self; Proteomics International. K. E. Peters: Employee; Self; Proteomics International, Stock/Shareholder; Self; Proteomics International. G. C. Fernandez: Employee; Self; Proteomics International, Stock/Shareholder; Self; Proteomics International. J. C. Morrison: Consultant; Self; Proteomics International. R. J. Lipscombe: Employee; Self; Proteomics International.

Renal surgery for kidney cancer: is preoperative proteinuria a predictor of functional and survival outcomes after surgery? A systematic review of the literature.

Proteinuria is considered both a known marker for the severity of chronic kidney disease (CKD) and a robust predictor of future renal function and cardiovascular morbidity and mortality in a general population. The urological community has long overlooked proteinuria as a marker of renal function. Recently, the American Urological Association (AUA) clinical practice guideline addressed this issue and suggested introducing proteinuria assessment prior to kidney cancer surgery. The aim of this systematic review was to provide evidence of proteinuria as a predictor of renal function impairment and survival outcomes after kidney surgery for renal tumors. A systematic search was performed by using three search engines (PubMed, Embase®, and Web of Science) from January 2010 to November 2020. Study selection followed the PRISMA guidelines. After screening, ten articles and abstracts fully compatible with the PICOS were included in this systematic review. Overall, a total of 11,705 patients who underwent partial nephrectomy (PN) or radical nephrectomy (RN) were analyzed. When used as a binomial variable, proteinuria prior to surgery was detected from 10% to 33% of patients. Relying on both proteinuria and estimated glomerular filtration rate (eGFR) in the assessment of renal function yielded up to 33% higher rates of patients with preoperative renal impairment. Moreover, proteinuria increased the risk of long-term renal impairment after PN and RN as well as patients with preoperative proteinuria undergoing PN exhibited a greater risk of postoperative acute kidney injury (AKI). Among eligible studies, proteinuria was associated with diabetes, obesity, metabolic syndrome, hypertension and cardiovascular disease. Finally, proteinuria was an independent predictor of overall mortality, but not of cancer-specific mortality. Proteinuria yields a prognostic power beyond that provided by estimated glomerular filtration rate (eGFR) among patients undergoing renal cancer surgery, supporting its introduction in the preoperative assessment of renal function. However, well-designed multicenter prospective studies would be necessary to corroborate these results and provided urological community with high-grade recommendation for clinical practice.

Ultrasound Measurement and Kidney Development: a Mini-Review for Nephrologists.

Ultrasound (US) is a noninvasive, simple and safe imaging investigation that can be done as many times as needed. Therefore, it is the primary imaging modality for evaluating kidneys. We carried out a literature review of information about ultrasonography for clinicians, especially nephrologists. US utilization from prenatal time till adult life with various measurements including, length, width, depth, and volume was searched during 2019. US identifies 90% of fetal kidneys by 20 weeks of gestational age. Kidney weight and volume at birth are approximately only 10% of the mature kidney. Kidney growth is most rapid during the first few weeks of life, with the kidney length increasing by as much as 15-20% in full-term neonates. There is a good correlation between relative function shown by scintigraphy and relative volume estimated from sonography. The most accurate measurement of kidney size is provided by kidney volume, which is correlated with subject's height, weight, and total body area. Kidney length is the most easily reproduced. Kidney volume is a better approximation of size than length because of the shape of the kidney varies considerably, but it is technically more demanding and needs four measurements in two different planes. It has been shown that in normal adult kidneys, the sonography measurements of kidney length differ by values of between about 1 cm and 1.85 cm in 95% of the cases, irrespective of whether the measurements are performed by the same or by different sonographers. Measuring the renal parenchyma with US is a novel method to assess fetal kidney development and predict future renal function.

Warm ischemic time’ and renal function preservation in robotic partial nephrectomy -evaluating its real impact

Objective: To evaluate the effect of warm ischemic time (WIT) on future renal function (RF) after robotic partial nephrectomy (RPN) and secondarily, also to find out predictors of future RF after RPN. Method and materials: All patients who underwent RPN with normal pre-operative RF and normal contralateral kidney were included in the study except for those in whom one-year follow up was not completed. Patients were divided in four groups based on WIT (zero, &lt;20minutes, 20 minutes to 30 minutes and &gt;30 minutes). Comparison of demographic and perioperative parameters including follow-up up to one year were done. Univariable and multivariable analysis were done to detect significant correlation of RF with those parameters. Results: Total 198 RPN patients were included in the study. The four groups had comparable demographic data (age, gender, comorbidity, smoking, body mass index, pre-operative RF). Progressively increased WIT was significantly associated with increased tumour size (p=0.022), RENAL nephrometry score (p=0.003), operative time (p=0.004) and blood loss (p=0.046). Post-operatively, RF on first post-operative day (p=0.627), at one month (p=0.581) and at one year (p=0.378) had no significant difference between the four groups. Nine (4.5%) patients progressed to chronic renal disease. Pre-operative RF and perioperative complications only had significant correlation with one-year RF. Conclusion: Tumour size and RENAL nephrometry score significantly influenced WIT. Pre-operative RF and peri-operative complications were the only significant predictors of future RF and not the WIT.

Quantitative levels of serum N-glycans in type 1 diabetes and their association with kidney disease.

We investigated associations of quantitative levels of N-glycans with hemoglobin A1c (HbA1c), renal function and renal function decline in type 1 diabetes. We measured 46 total N-glycan peaks (GPs) on 1565 serum samples from the Scottish Diabetes Research Network Type 1 Bioresource Study (SDRNT1BIO) and a pool of healthy donors. Quantitation of absolute abundance of each GP used 2AB-labeled mannose-3 as a standard. We studied cross-sectional associations of GPs and derived measures with HbA1c, albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), and prospective associations with incident albuminuria and final eGFR. All GPs were 1.4 to 3.2 times more abundant in SDRTN1BIO than in the healthy samples. Absolute levels of all GPs were slightly higher with higher HbA1c, with strongest associations for triantennary trigalactosylated disialylated, triantennary trigalactosylated trisialylated structures with core or outer arm fucose, and tetraantennary tetragalactosylated trisialylated glycans. Most GPs showed increased abundance with worsening ACR. Lower eGFR was associated with higher absolute GP levels, most significantly with biantennary digalactosylated disialylated glycans with and without bisect, triantennary trigalactosylated trisialylated glycans with and without outer arm fucose, and core fucosylated biantennary monogalactosylated monosialylated glycans. Although several GPs were inversely associated prospectively with final eGFR, cross-validated multivariable models did not improve prediction beyond clinical covariates. Elevated HbA1c is associated with an altered N-glycan profile in type 1 diabetes. Although we could not establish GPs to be prognostic of future renal function decline independently of HbA1c, further studies to evaluate their impact in the pathogenesis of diabetic kidney disease are warranted.

PromarkerD Predicts Renal Function Decline in Type 2 Diabetes in the Canagliflozin Cardiovascular Assessment Study (CANVAS).

The ability of current tests to predict chronic kidney disease (CKD) complicating diabetes is limited. This study investigated the prognostic utility of a novel blood test, PromarkerD, for predicting future renal function decline in individuals with type 2 diabetes from the CANagliflozin CardioVascular Assessment Study (CANVAS). PromarkerD scores were measured at baseline in 3568 CANVAS participants (n = 1195 placebo arm, n = 2373 canagliflozin arm) and used to predict incident CKD (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 during follow-up in those above this threshold at baseline) and eGFR decline ≥30% during the 4 years from randomization. Biomarker concentrations (apolipoprotein A-IV (apoA4), CD5 antigen-like (CD5L/AIM) and insulin-like growth factor-binding protein 3 (IGFBP3) measured by mass spectrometry were combined with clinical data (age, serum high-density lipoprotein (HDL)-cholesterol, eGFR) using a previously defined algorithm to provide PromarkerD scores categorized as low-, moderate- or high-risk. The participants (mean age 63 years, 33% females) had a median PromarkerD score of 2.9%, with 70.5% categorized as low-risk, 13.6% as moderate-risk and 15.9% as high-risk for developing incident CKD. After adjusting for treatment, baseline PromarkerD moderate-risk and high-risk scores were increasingly prognostic for incident CKD (odds ratio 5.29 and 13.52 versus low-risk, respectively; both p < 0.001). Analysis of the PromarkerD test system in CANVAS shows the test can predict clinically significant incident CKD in this multi-center clinical study but had limited utility for predicting eGFR decline ≥30%.

The effect of diabetes during pregnancy on fetal renal parenchymal growth.

Diabetes in pregnancy is thought to adversely affect the developing fetalkidneys. The rate of gestational diabetes is increasing globally with major consequences for future renal function. Very little is known about the impact of hyperglycaemia on the fetal renal parenchyma which contains the developing nephrons. The aim of this study was to measure the fetal renal parenchymal thickness and evaluate whether diabetes during pregnancy affects the growth of the fetal kidneys. This prospective, observational study used serial ultrasound measurements to evaluate the fetal renal parenchymal growth of 55 pregnancies with diabetes compared to 72 control pregnancies. Mixed effects modelling was used to analyse the data. The renal parenchyma of fetuses from mothers with gestational diabetes was significantly thicker than those from the control group (LR Chisq = 4.8, df = 1, p = 0.029), however, the difference was proportional to the larger size of these fetuses. Fetuses of pregestational diabetics demonstrated no significant difference in renal parenchymal thickness compared to the control group even though they were also larger fetuses. Parenchymal growth slowed with increasing abdominal circumference in the pregestational diabetic group, suggesting an adverse effect on nephrogenesis, however this did not reach statistical significance. Our study provides unique data on how diabetes during pregnancy influences fetal kidney growth. Appropriate management of diabetic pregnancies may mitigate some of the adverse effects on the fetal kidneys. Increasing degrees of hyperglycaemia, as seen sometimes in pregestational diabetes, may affect nephrogenesis; however larger studies are needed.

Childhood risk factors for adulthood chronic kidney disease.

Chronic kidney disease (CKD) is a major public health challenge, affecting as much as 8 to 18% of the world population. Identifying childhood risk factors for future CKD may help clinicians make early diagnoses and initiation of preventive interventions for CKD and its attendant comorbidities as well as monitoring for complications. The purpose of this review is to describe childhood risk factors that may predict development of overt kidney disease later in life. Currently, there are multiple childhood risk factors associated with future onset and progression of CKD. These risk factors can be grouped into five categories: genetic factors (e.g., monogenic or risk alleles), perinatal factors (e.g., low birth weight and prematurity), childhood kidney diseases (e.g., congenital anomalies, glomerular diseases, and renal cystic ciliopathies), childhood onset of chronic conditions (e.g., cancer, diabetes, hypertension, dyslipidemia, and obesity), and different lifestyle factors (e.g., physical activity, diet, and factors related to socioeconomic status). The available published information suggests that the lifelong risk for CKD can be attributed to multiple factors that appear already during childhood. However, results are conflicting on the effects of childhood physical activity, diet, and dyslipidemia on future renal function. On the other hand, there is consistent evidence to support follow-up of high-risk groups.